Investigating investment strategies for tackling antibiotic resistance. A quantitative and qualitative assessment.
File(s)
Author(s)
Chatterjee, Anuja
Type
Thesis
Abstract
Antibiotic resistance (AbR) is a growing, multifaceted public-health concern. Bacteria harbouring AbR are found in diverse hosts, human and animal, and in the environment. To further our current understanding of AbR, four key evidence frameworks are needed.
Firstly, there has been no systematic retrieval or assessment of the evidence on the multi-setting risk factors across all drug-bug combinations of AbR in humans. Secondly few frameworks examine how well the currently implemented interventions are targeting key risks driving AbR. Thirdly, future investment needs in light of the Points 1-2 above are lacking. Lastly, an assessment of the process-level-barriers to tackling AbR is needed for successful implementation of interventions. This thesis aims to inform these four evidence frameworks and provide policymakers tools to investigate investment strategies to tackle AbR in humans.
METHOD
Four key methods were utilised to meet the objectives of this thesis. Firstly, a systematic review was conducted to identify key risk factors of AbR. Secondly, a network-mapping technique was applied to explore clinical-effectiveness of currently implemented interventions. Thirdly, a dynamic transmission model was used to investigate areas of better resource-allocation. Lastly, a qualitative study was conducted using a systems-thinking approach to develop causal-loop models that identified process-level barriers to tackling AbR.
FINDINGS
Easier to quantify risks of AbR are being targeted by policy and ground-level interventions using a top-down implementation approach. Current interventions have limited evidence on their long-term efficacy of tackling AbR. For cost-efficiency, the model recommends policymakers to focus investment in the community. The interconnectivity of system-level factors (e.g. infrastructure, competing-priorities) impact system-wide engagement which fuel the process-level barriers to tackling AbR.
CONCLUSION
To help identify targets for sustainable interventions, research investment is needed to further investigate underlying factors driving AbR. Awareness of the drivers of AbR leading to greater engagement could enable successful implementation of long-term measures to effectively tackle AbR.
Firstly, there has been no systematic retrieval or assessment of the evidence on the multi-setting risk factors across all drug-bug combinations of AbR in humans. Secondly few frameworks examine how well the currently implemented interventions are targeting key risks driving AbR. Thirdly, future investment needs in light of the Points 1-2 above are lacking. Lastly, an assessment of the process-level-barriers to tackling AbR is needed for successful implementation of interventions. This thesis aims to inform these four evidence frameworks and provide policymakers tools to investigate investment strategies to tackle AbR in humans.
METHOD
Four key methods were utilised to meet the objectives of this thesis. Firstly, a systematic review was conducted to identify key risk factors of AbR. Secondly, a network-mapping technique was applied to explore clinical-effectiveness of currently implemented interventions. Thirdly, a dynamic transmission model was used to investigate areas of better resource-allocation. Lastly, a qualitative study was conducted using a systems-thinking approach to develop causal-loop models that identified process-level barriers to tackling AbR.
FINDINGS
Easier to quantify risks of AbR are being targeted by policy and ground-level interventions using a top-down implementation approach. Current interventions have limited evidence on their long-term efficacy of tackling AbR. For cost-efficiency, the model recommends policymakers to focus investment in the community. The interconnectivity of system-level factors (e.g. infrastructure, competing-priorities) impact system-wide engagement which fuel the process-level barriers to tackling AbR.
CONCLUSION
To help identify targets for sustainable interventions, research investment is needed to further investigate underlying factors driving AbR. Awareness of the drivers of AbR leading to greater engagement could enable successful implementation of long-term measures to effectively tackle AbR.
Version
Open Access
Date Issued
2019-06
Date Awarded
2019-09
Copyright Statement
Creative Commons Attribution NonCommercial NoDerivatives Licence
Advisor
Robotham, Julie
Barlow, James
Holmes, Alison
Atun, Rifat
Sponsor
National Institute of Health Research (Great Britain)
Publisher Department
Department of Medicine
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)